title: Impact of tumor chronology and tumor biology on lymph node metastasis in breast cancer.
abstract: CONCLUSIONS
  The significance of nodal metastasis in breast cancer is under discussion. We investigated the impact of variables of tumor chronology and tumor biology on the presence of lymph node metastases.
  
  
  OBJECTIVE
  Lymph node involvement is the main prognostic factor in breast cancer. However, it is under discussion whether nodal metastasis in breast cancer only reflects the chronological age of the tumor or whether it is also a marker of tumor biology. The goal of our study was to investigate the impact of variables of tumor chronology and biology on the presence of lymph node metastases.
  
  
  METHODS
  We performed a retrospective analysis of data from 3002 patients with an early invasive breast carcinoma. All patients underwent primary surgery at the University Hospitals Leuven between 2001 and 2009. First, the impact of tumor size on the presence of lymph node metastasis was evaluated as the chronological age of a tumor is supposed to be reflected in its size. Next, the impact of tumor grade, lymphovascular invasion and the hormone receptor status, which are all variables of tumor biology, was studied. Logistic regression analyses were performed and the area under the ROC curve (AUC) was calculated as a measure of discrimination between logistic regression models.
  
  
  RESULTS
  Using pathological tumor size the AUC of prediction was 0.67. Based on variables of tumor biology, axillary lymph node positivity could be predicted with an AUC of 0.68. Combining variables of tumor chronology and biology an AUC of 0.74 for the prediction of axillary lymph node (ALN) positivity was calculated.
  
  
  CONCLUSIONS
  According to our data variables of tumor chronology and tumor biology have a similar impact on the presence of lymph node metastasis.
authors.affiliation: Multidisciplinary Breast Center, KU Leuven, University Hospitals Leuven, Leuven, Belgium ; Department of Oncology, KU Leuven, Surgical Oncology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Ann
authors.initials: A
authors.lastname: Smeets
authors.forename: Andries
authors.initials: A
authors.lastname: Ryckx
authors.forename: Ann
authors.initials: A
authors.lastname: Belmans
authors.forename: Hans
authors.initials: H
authors.lastname: Wildiers
authors.forename: Patrick
authors.initials: P
authors.lastname: Neven
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Floris
authors.forename: Patrick
authors.initials: P
authors.lastname: Schöffski
authors.forename: Marie-Rose
authors.initials: MR
authors.lastname: Christiaens
keywords: Breast cancer; Lymph node; Metastasis; Tumor biology; Tumor chronology